The application of completion mastectomy and immediate reconstruction in a patient unable to undergo radiotherapy following breast conserving surgery: a case report
DOI:
https://doi.org/10.18203/2349-2902.isj20213141Keywords:
Breast conserving surgery, Adjuvant radiotherapy, MastectomyAbstract
Breast conserving surgery (BCS) with adjuvant radiotherapy (RT) confers an equivalent 20 year survival rate to mastectomy. Concerningly, 15% of BCS patients do not receive RT. Several barriers to completing RT have been described. However, non-compliance with post-BCS radiotherapy due to severe claustrophobia is not well documented in the literature. We report the case of a patient who declined radiotherapy following BCS due to severe claustrophobia. With advances in oncoplastic breast surgery, completion nipple-sparing mastectomy (NSM) may be an alternative to simple mastectomy in BCS patients unable to undergo RT. NSM is an oncoplastic procedure that involves attaining complete oncologic resection whilst sparing the nipple-areolar complex. Recent literature highlights that NSM has more favourable aesthetic outcomes and improves quality of life compared to simple mastectomy. This report further describes the novel use of NSM and reconstruction for the case patient and highlights its potential use in patients who are unable to undergo neoadjuvant RT.
References
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer. N Engl J Med. 2002;347(16):1233-41.
Group EBCTC. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group. Lancet. 2000;355(9217):1757-70.
Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087-106.
Guidolin K, Lock M, Brackstone M. Patient-perceived barriers to radiation therapy for breast cancer. Canad J Surg. 2018;61(2):141-3.
Pan IW, Smith BD, Shih Y-CT. Factors contributing to underuse of radiation among younger women with breast cancer. J Natl Cancer Inst. 2014;106(1):340.
Veronesi U, Stafyla V, Petit J-Y, Veronesi P. Conservative mastectomy: extending the idea of breast conservation. Lancet Oncol. 2012;13(7):311-7.
Ferrari A, Sgarella A, Zonta S. Nipple Sparing Mastectomy: Minimally invasive video-assisted technique. Springer, editor. 2013.
Spear SL, Willey SC, Feldman ED, Cocilovo C, Sidawy M, Al-Attar A, et al. Nipple-sparing mastectomy for prophylactic and therapeutic indications. Plastic and reconstructive surgery. 2011;128(5):1005-14.
Jadeja P, Ha R, Rohde C, Ascherman J, Grant R, Chin C, et al. Expanding the Criteria for Nipple-Sparing Mastectomy in Patients With Poor Prognostic Features. Clinical breast cancer. 2018;18(3):229-33.
Lee CH, Cheng MH, Wu CW, Kuo WL, Yu CC, Huang JJ. Nipple-sparing Mastectomy and Immediate Breast Reconstruction After Recurrence From Previous Breast Conservation Therapy. Ann Plast Surg. 2019;82(1):95-102.
Loveland-Jones C, Lin H, Shen Y, Bedrosian I, Shaitelman S, Kuerer H, et al. Disparities in the Use of Postmastectomy Radiation Therapy for Inflammatory Breast Cancer. International journal of radiation oncology, biology, physics. 2016;95(4):1218-25.
Guidolin K, Lock M, Richard L, Boldt G, Brackstone M. Predicting which patients actually receive radiation following breast conserving therapy in Canadian populations. Canadian journal of surgery. 2016;59(5):358-60.
Steggles S. The use of cognitive-behavioral treatment including hypnosis for claustrophobia in cancer patients. The American journal of clinical hypnosis. 1999;41(4):319-26.
Enders J, Zimmermann E, Rief M, Martus P, Klingebiel R, Asbach P, et al. Reduction of Claustrophobia with Short-Bore versus Open Magnetic Resonance Imaging: A Randomized Controlled Trial. PLOS One. 2011;6(8):e23494.
Heyer CM, Thuring J, Lemburg SP, Kreddig N, Hasenbring M, Dohna M, et al. Anxiety of patients undergoing CT imaging-an underestimated problem? Academic radiology. 2015;22(1):105-12.
Montel S. A case report of claustrophobia with panic attack due to an MRI, treated by cognitive-behavioral therapy. La Revue de medecine interne. 2009;30(7):620-4.
Thorpe S, Salkovskis PM, Dittner A. Claustrophobia in MRI: the role of cognitions. Magnetic resonance imaging. 2008;26(8):1081-8.
